NAMS Certification
Physiology of VMS - ANS--thermoregulatory center altered by increase in KNDy
neurons
-activation of NK3R causes hot flashes
-blockade of NK3R reduces/eliminates hot flashes
-may also be affected by: serotonin, epinephrine, and norepinephrine; parasympathetic
nerve activity
Off label rx for VMS - ANS--SSRIs
-SNRIs
-Gabapentinoids
-Clonidine
-Oxybutynin
Studies on Fractional Co2 Laser for GSM - ANS--not FDA approved
-vaginal symptoms and sexual function scores increased significantly at 3 mon; noted
continued improvement at 1y
Ospemifene (Osphena) indications and MOA - ANS--for treatment of dyspareunia
-decreases vaginal pH
-improves vaginal dryness
-shifts vaginal maturational index to superficial cells
-estrogen agonist/antagonist
Ospemifene (Osphena) adverse effects - ANS--increase in uterine polyps
-proliferative endometrium
-slight increased risk of hemorrhagic stroke and VTE
-can increase VMS
treatment of urge incontinence - ANS--behavioral modifications
-overactivity of the detrusor muscle
-antimuscarinics: *oxybutynin*
-nerve stimulation
-botox
What is low-tone pelvic floor dysfunction? - ANS--weak, underactive and hypotonic
muscles that cannot maintain adequate contraction
What is high-tone Pelvic Floor Dysfunction? - ANS--weak pelvic floor muscles cannot
attain or maintain adequate relaxation
-muscles are overactive, hypertonic, spastic, shortened
What are the symptoms of low-tone PFD? - ANS--heaviness
-pressure
-pelvic organ prolapse
-incontinence
-altered sexual sensation
What are the symptoms of high-tone PFD? - ANS--urinary retention
-frequency
-urgency
-dysuria
-fecal retention/constipation
-penetrative dyspareunia and/or vaginismus
Vaginal dilators for PFD - ANS--Choose size that does not cause pain
-Show how to insert with a mirror
-Apply lubricant to dilator, insert dilator as far as is comfortable, leave dilator in place
for 5-10 min 1-2 times daily
-Use each for 4 wk before progressing to a size similar to partner size
HRT and cognition - natural menopause - ANS-In RCT, HRT has little or no overall
effect on short or long-term cognition
HRT and cognition - surgical menopause - ANS-HRT may be beneficial in improving
verbal memory in the short term
In the SWANN survey, which groups of women were most likely to experience sleep
disturbance? - ANS--late perimenopause (45%)
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